Effects of yoga vs placebo on inflammation among cancer survivors: A nationwide multicenter phase III randomized controlled trial (RCT).
Authors: Po-Ju Lin, Hongying Sun, Umang Gada, Richard Francis Dunne, Ian Kleckner, Evelyn Arana, Alisha Chakrabarti, Stephen Rajan Samuel, Charles Stewart Kamen, Janos Molnar, John Scott Maul, Judith O. Hopkins, Karen Michelle Mustian
Journal: Journal of Clinical Oncology (2023)

12111 Background: Inflammation, both acute and chronic, is universally associated with primary and secondary cancer development and progression, as well as a myriad of toxicities that negatively affect cancer treatment adherence and survival. The effectiveness of targeting inflammation with non-pharmaceutical therapies such as yoga is not known. As part of a nationwide, multicenter, phase III RCT with cancer survivors, we compared the effects of yoga (Yoga for Cancer Survivors; YOCAS) to a behavioral placebo (survivorship health education) on inflammation (i.e. pro-inflammatory, anti-inflammatory, and overall inflammatory status). Methods: Participants were recruited via the URCC NCORP Research Base in partnership with 23 community oncology practices across the United States. Eligible participants were cancer survivors with insomnia 2-60 months post-treatment. They were randomized to receive YOCAS (gentle Hatha and Restorative yoga, 75-min./session, 2x/week, 4 weeks) or placebo (ASCO survivorship recommendation-based health education, 75-min./session, 2x/week, 4 weeks). Serum samples were collected at baseline and post-intervention to assess inflammation (i.e., pro-inflammatory markers IL-1β, IL-6, TNF-α, IFN-γ and anti-inflammatory markers IL-4, IL-8, IL-10, sTNFRI), via Luminex multiplex assays. Analysis of covariance (ANCOVA) and structural equation modeling (SEM) were used to access yoga's effects on inflammation. Results: 502 survivors (94% female, mean age 56±11 years, 74% breast cancer) were enrolled. ANCOVAs revealed significantly lower levels of pro-inflammatory markers in YOCAS participants compared to placebo participants (IL-1β: -0.07±0.03, p = 0.01; TNF-α: -0.04±0.02, p = 0.08; IFN-γ: -0.07±0.03, p = 0.02) where YOCAS participants exhibited stable pro-inflammatory responses (all p &gt; 0.05) and placebo participants exhibited significant increases in pro-inflammatory responses (all p≤0.05) from baseline to post-intervention. ANCOVAs also revealed a statistical trend toward lower levels of anti-inflammatory markers in YOCAS participants compared to placebo participants (IL-4: -0.06±0.04, p = 0.10; IL-10: -0.06±0.04, p = 0.09; sTNFRI: -0.06±0.04, p = 0.09). SEM also demonstrated significantly lower pro-inflammatory status (-0.16±0.03, p &lt; 0.01), significantly lower anti-inflammatory status (-0.14±0.03, p = 0.03), and significantly lower overall inflammatory status (-0.15±0.03, p = 0.01) in YOCAS participants compared to placebo participants. Conclusions: Our data suggest that YOCAS yoga significantly reduces inflammation among cancer survivors. Clinicians should consider prescribing yoga for survivors experiencing inflammation, which may lead to a high chronic toxicity burden and increased risk of progression, recurrence, and second cancers. Funding: NCI UG1CA189961, R01CA181064, T32CA102618. Clinical trial information: NCT02613364 .